Hepatocellular carcinoma (HCC), the major histological form of primary liver cancer, affects approximately half a million persons each year, making it the fifth most common malignancy and the third most common cause of cancer death worldwide.1 The etiology of HCC is mainly associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) chronic infection.2 In the past decade, there has been a rising incidence of HCC and a progressive increase in HCC-related mortality in the United States and Western Europe.3, 4 The similarity between incidence and mortality rates is indicative of the rapid death after diagnosis in most cases of HCC, with a 5-year survival rate of less than 5%.3 The poor survival of patients with HCC is largely related to the lack of reliable tools for early diagnosis. At-risk patients with chronic viral hepatitis and cirrhosis are routinely screened for HCC with annual serum alpha-fetoprotein (AFP) and ultrasonography (for healthy hepatitis B virus carriers) or with twice-yearly serum AFP and ultrasonography (for patients with cirrhosis of any etiology).5 However, the usefulness of AFP as a marker has been overshadowed by its inability to diagnose early-stage tumors efficiently;6, 7 AFP levels may increase transiently, intermittently, or permanently in patients with viral hepatitis without HCC. The lack of efficiency of AFP as a serum marker for HCC surveillance or diagnosis has led to assessment of other serological markers such as alpha-1-antitrypsin,8 des-gamma-carboxyprothrombin,9, 10 glycipan-3,11 or isoenzymes of gamma-glutamyltransferase.12, 13 